Please complete this brief on-line survey for the chance to WIN* a year’s supply of COLD-fX.
See Rules & Regulations for details. 		 
   
Your Contact Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Daytime Phone: ( ) -
Email Address:
 
   
Your personal information will not be shared with any other marketers and will only be used by fX Life Sciences International GmbH for the purposes you have consented to and in accordance with privacy laws and our privacy policy.

Yes, please include me on the mailing list for future COLD-fX information and promotions.
Yes, please include me on the mailing list for information about other products manufactured by fX Life Sciences International GmbH.		  
   

1. Have you ever used COLD-fX before?

Yes
  Which of the following statements best describes how you use COLD-fX?
   
No
  Please select the most accurate statement.

2. What is your gender?

3. What age group do you fall under?

4. How did you hear about COLD-fX? (Please check all that apply)
Friend, family member or work colleague
Pharmacist or doctor
Story in the news mentioning COLD-fX
Search engine results (Google, Yahoo, MSN, etc.)
Advertisement
Someone from Canada
Interview with Mark Messier
NHL Events
Health newsletter or website

  
 
   
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*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

† The product name refers to the traditional cooling energy of the source material. In accordance with U.S. regulations, this product is not intended to
treat, cure or prevent upper respiratory infections due to cold or influenza-like viruses.

TM/® – owned by fX Life Sciences International GmbH